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Claims Professional Jobs in Riverside, CA (NOW HIRING)

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

... professional customer service with providers and internal stakeholders. · Working knowledge of HIPAA transactions (837/835) and claims-related regulatory requirements including prompt pay and ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

... professional customer service with providers and internal stakeholders. • Working knowledge of HIPAA transactions (837/835) and claims-related regulatory requirements including prompt pay and ...

Chubb

ESIS Claims Representative, WC

Irvine, CA · On-site

Gains exposure to all facets of a professional claims representative position through classroom and hands on learning. Will be assigned a caseload as training progresses. Duties may include but are ...

Venbrook

Senior Claims Examiner

Anaheim, CA · On-site

$69K - $89K/yr

Professional development programs * Work-life quality and flexibility Visit us at JOB SUMMARY The Claims Adjuster, Public Entity is responsible for the end-to-end management of property and casualty ...

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Claims Professional information

See Riverside, CA salary details

$16

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$47

How much do claims professional jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for claims professional in Riverside, CA is $30.67, according to ZipRecruiter salary data. Most workers in this role earn between $23.32 and $36.63 per hour, depending on experience, location, and employer.

What is a claims professional?

Claims Professionals are specialists who handle insurance claims on behalf of insurance companies or policyholders. Their main responsibilities include investigating, evaluating, and settling claims to ensure fair compensation is provided in accordance with the terms of the insurance policy. They often interact with clients, assess damage or loss, and work with other professionals such as adjusters and legal experts to resolve disputes. Claims Professionals play a critical role in ensuring that claims are processed efficiently and accurately, maintaining trust between insurers and their clients.

What is the difference between Claims Professional vs Claims Adjuster?

AspectClaims ProfessionalClaims Adjuster
CredentialsCertifications like CPCU, ARM, or state licensing often preferredSimilar certifications, often required or preferred
Work EnvironmentOffice-based, administrative, and customer service rolesField or desk-based, investigating and evaluating claims
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms

Claims Professionals and Claims Adjusters both work within the insurance industry, often sharing similar certifications and work environments. However, Claims Professionals typically focus on administrative tasks, policy management, and customer service, while Claims Adjusters are more involved in investigating and evaluating claims, often in the field. Understanding these differences helps job seekers target the right roles within the insurance sector.

What are some common challenges faced by claims professionals, and how can they be addressed on the job?

Claims Professionals often encounter challenges such as managing a high volume of cases, navigating complex policy details, and communicating effectively with clients who may be experiencing stress. To address these challenges, it is important to stay organized, leverage claims management software, and develop strong interpersonal skills. Regular training on policy updates and clear communication with both clients and colleagues can also help ensure efficient and fair claims resolution.

What are the key skills and qualifications needed to thrive as a claims professional, and why are they important?

To thrive as a Claims Professional, you need strong analytical skills, attention to detail, and a background in insurance or finance, often supported by a bachelor's degree. Familiarity with claims management systems, industry-specific software such as Guidewire, and relevant certifications like AIC (Associate in Claims) is highly valuable. Excellent communication, negotiation, and problem-solving abilities help you effectively interact with clients and resolve disputes. These skills are essential for accurately assessing claims, minimizing risk, and ensuring customer satisfaction throughout the claims process.
What are the most commonly searched types of Claims jobs in Riverside, CA? The most popular types of Claims jobs in Riverside, CA are:
What are popular job titles related to Claims Professional jobs in Riverside, CA? For Claims Professional jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Claims Professional jobs in Riverside, CA look for? The top searched job categories for Claims Professional jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Claims Professional jobs? Cities near Riverside, CA with the most Claims Professional job openings:
Claims Professional jobs near you
Infographic showing various Claims Professional job openings in Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 21% Part Time, and 6% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $63,802 per year, or $30.7 per hour.

Claims Examiner

LSMA Management Inc

San Bernardino, CA • On-site

$28.85 - $33.65/hr

Full-time

Re-posted 10 hours ago

Job description

Description:

JOB SUMMARY

The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and Independent Practice Association (IPA) groups. This role applies plan and contract rules, reimbursement methodologies, and medical billing/coding guidelines to ensure claims are processed accurately, timely, and in compliance with federal and California requirements. The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization Management, Finance, Member/Patient Services, and Compliance to resolve pended claims, denials, adjustments, and provider disputes while meeting production and quality standards.

Requirements:

MINIMUM & PREFERRED QUALIFICATIONS


Education

Minimum: High school diploma or equivalent, or equivalent combination of education and experience.

Experience

Minimum: Two years of healthcare claims processing or claims adjudication experience, including experience interpreting benefits and reimbursement rules. Experience working with claim denials, adjustments, and provider inquiries. Working knowledge of medical billing/coding basics (CPT, HCPCS, ICD-10, revenue codes) and how coding impacts adjudication. Experience using claims systems and/or EDI workflows preferred.


Skills, Knowledge & Abilities

· Knowledge of end-to-end claims lifecycle including intake, edits, adjudication, pricing, payment, denials, adjustments, and recoveries.

· Ability to interpret provider contracts, fee schedules, and reimbursement methodologies (FFS, DRG/APC, capitation, bundled payments).

· Strong analytical and problem-solving skills; able to research discrepancies and determine appropriate resolution.

· Attention to detail and accuracy with ability to meet production, turnaround time, and quality standards.

· Effective written and verbal communication; professional customer service with providers and internal stakeholders.

· Working knowledge of HIPAA transactions (837/835) and claims-related regulatory requirements including prompt pay and dispute resolution.

Proficient with claims systems, Microsoft Office/Google Workspace, and basic reporting tools.


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and data review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Occasional lifting of materials up to approximately 10–20 pounds may be required. The position may require extended work hours or weekend work to meet operational and regulatory deadlines.


PAY RANGE

$28.85 - $33.65 / hourly

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